Advanced Practices in Voice & Dysphagia Registration
Step 1 of 3: Submit
First Name (as it should appear on your badge)
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Surname (please do not include any middle names)
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Title
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Select an option:
MD
SLP
PhD
DO
ARNP
PA
SLP Master's Student
Resident
Fellow
Other
Country
Select your country:
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo - Democratic Republic of
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equitorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guyana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia - Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French Part)
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch Part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Isl.
South Korea
South Sudan
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Isl.
United States Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wallis and Futuna
West Bank
Western Sahara
Yemen
Zambia
Zimbabwe
European Union
Address
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City
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State/Province
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
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Phone Number
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Email Address
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Date of Birth
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NPI Number
ASHA Number
JHC Number
Attendance Option
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MD - Laryngology Course AND Sinus Course ($925 USD)
MD - Laryngology Course Only ($725 USD)
MD - Sinus Course Only ($275 USD)
SLP/Other - Laryngology Course AND Voice Course ($700 USD)
SLP/Other - Laryngology Course Only ($525 USD)
SLP/Other - Voice Course Only ($200 USD)
ARNP/PA - Laryngology Course AND Sinus Course ($825 USD)
ARNP/PA - Laryngology Course Only ($625 USD)
ARNP/PA - Sinus Course Only ($275 USD)
Resident/Fellow - Laryngology Course AND Sinus Course ($655 USD)
Resident/Fellow - Laryngology Course Only ($500 USD)
Resident/Fellow - Sinus Course Only ($210 USD)
SLP Master's Student - Laryngology Course AND Voice Course ($495 USD)
SLP Master's Student - Laryngology Course Only ($360 USD)
SLP Master's Student - Voice Course Only ($155 USD)
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indicates required fields